Pulmonology Coding Alert
Get Ready for More Than 800 Nonmutually Exclusive Bundles
Modifier 59 helps you report 3 G codes accurately A trio of injection and intravenous push codes could soon trigger denials if you report them with such procedures as bronchoscopies and laryngoscopies. Keep definitions straight: Nonmutually exclusive edits pair codes for two services that physicians often perform during the same session. NCCI lists one code as the comprehensive procedure, meaning it's the more extensive service. The second code of the pair is a component of the first, which means only in certain circumstances can you charge for both services, says William J. Conner, MD, founder of Conner Health Clinic, a multispecialty practice in Charlotte, N.C. Notify Payers for Separately Billable Services Example: Your pulmonologist administers a light-activated drug, Photofrin, for photodynamic therapy to an inoperable lung cancer patient. The pulmonologist then performs a bronchoscopy during which he transmits light of specific wavelengths to the lung tumor.
The latest National Correct Coding Initiative edits, version 11.2, which go into effect July 1, will bundle three specific injection and intravenous push codes (G0351, G0353, and G0354) in column 2 into hundreds of pulmonology codes in column 1.
The new edits include codes in column 2 that carriers bundle into the codes in column 1. These are services that physician can provide during the same patient encounter but should not be reported together.
Exception: A "1" in the modifier column indicates that you can append modifier 59 (Distinct procedural service) to unbundle these procedures, as long as your documentation supports two separate services. The bundles include the following codes in column 2:
Old way: Prior to the 11.2 edits, you would report G0353 in addition to your specific bronchoscopy code (31641, Bronchoscopy [rigid or flexible]; with destruction of tumor or relief of stenosis by any method other than excision [e.g., laser therapy, cryotherapy]).
New way: With the 11.2 edits, you should not report G0353 in addition to 31641 unless the pulmonologist also administers an injectable drug separately billable from the patient's photodynamic therapy and bronchoscopy, says Alan L. Plummer, MD, professor of medicine, division of pulmonary, allergy and critical care at Emory University School of Medicine in Atlanta.
If the pulmonologist does administer an intravenous injection for a reason separate from the patient's lung cancer, you could report G0353 in addition to the procedure code but only with modifier 59 appended to the injection code and the proper documentation, Plummer says.
Another example: The pulmonologist administers 5 mgs of Valium to a patient prior to performing a diagnostic laryngoscopy with a lung biopsy.
Old way: Prior to the 11.2 edits, you would report G0353 for the Valium administration and 31510 (Laryngoscopy, indirect; with biopsy).
New way: After July 1, you should only report 31510 for both the procedure and the Valium administration.
Note: To view the latest update, see www.cms.hhs.gov/physicians/cciedits/default.asp.
Pulmonology Coding Alert
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